Acute Kidney Injury Is Common in Pediatric Severe Malaria and Is Associated With Increased Mortality

Conroy, Andrea L.; Hawkes, Michael; Elphinstone, Robyn E.; Morgan, Catherine; Hermann, Laura; Barker, Kevin R.; Namasopo, Sophie; Opoka, Robert O.; John, Chandy C.; Liles, W. Conrad; Kain, Kevin C.

doi:10.1093/ofid/ofw046

Cited by 79 publications

(120 citation statements)

References 42 publications

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“…143 The resulting optically transparent tissue allows high resolution 3D imaging of large (cm) sections of tissue and could provide a more comprehensive overview of endothelial junctional protein distribution in severe malaria. Beyond the brain and lung, applying these methods to the analysis of renal tissue from patients with severe malaria could provide additional insight into acute kidney injury in both children 144 and adults 43 which is associated with renal endothelial cell hypertrophy and cytoplasmic vacuolation as well as monocyte infiltration. 42 …”

Section: Imaging Studiesmentioning

confidence: 99%

Dynamic interactions ofPlasmodiumspp. with vascular endothelium

Gillrie

2016

Tissue Barriers

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Plasmodial species are protozoan parasites that infect erythrocytes. As such, they are in close contact with microvascular endothelium for most of the life cycle in the mammalian host. The hostparasite interactions of this stage of the infection are responsible for the clinical manifestations of the disease that range from a mild febrile illness to severe and frequently fatal syndromes such as cerebral malaria and multi-organ failure. Plasmodium falciparum, the causative agent of the most severe form of malaria, is particularly predisposed to modulating endothelial function through either direct adhesion to endothelial receptor molecules, or by releasing potent host and parasite products that can stimulate endothelial activation and/or disrupt barrier function. In this review, we provide a critical analysis of the current clinical and laboratory evidence for endothelial dysfunction during severe P. falciparum malaria. Future investigations using state-of-the-art technologies such as mass cytometry and organs-on-chips to further delineate parasite-endothelial cell interactions are also discussed.

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Section: Imaging Studiesmentioning

confidence: 99%

Dynamic interactions ofPlasmodiumspp. with vascular endothelium

Gillrie

2016

Tissue Barriers

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“…Since that meta-analysis, more studies from Africa have emerged on pediatric AKI and they have focused on infection-related AKI (e.g., AKI in those with malaria) or non-surgical-related AKI [4][5][6]. Trauma is also a likely risk factor.…”

Section: Introductionmentioning

confidence: 99%

Incidence and epidemiology of acute kidney injury in a pediatric Malawian trauma cohort: a prospective observational study

et al. 2020

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Background: Acute kidney injury (AKI) is highly associated with mortality risk in children worldwide. Trauma can lead to AKI and is a leading cause of pediatric death in Africa. However, there is no information regarding the epidemiology of pediatric, trauma-associated AKI in Africa.Methods: Prospective cohort study of pediatric trauma patients admitted to a tertiary referral hospital in Malawi. Participants enrolled at admission were followed prospectively throughout their hospitalization. AKI was defined by creatinine-only Kidney Disease Improving Global Outcomes criteria. We calculated descriptive statistics and univariate relative risks (RR) for hypothesis-generation of potential risk factors associated with AKI. Results: We analyzed data from 114 participants. Depending on baseline creatinine definition, AKI incidence ranged from 4 to 10%. The new Schwartz equation estimated baseline creatinine values best and yielded an AKI incidence of 9.7%. Almost one in ten children died during hospitalization, but those with AKI (n = 4) were at significantly higher risk of death compared to those without AKI (40.0% vs 6.2%; RR 6.5, 95% CI 2.2-19.1). Burn injuries were most commonly associated with AKI (63.6%). Other potential AKI risk factors included multiple injuries, trunk or facial injuries, and recent consumption of herbal remedies. Conclusions: AKI occurs in up to 10% of admitted pediatric trauma patients in Malawi and increases the risk of death 7-fold compared to those without AKI. This large unrecognized burden in trauma requires further investment by researchers, clinicians and policymakers to develop evidenced-based triage, recognition, and management approaches to prevent the associated sequelae and potential mortality from AKI.

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“…According to World Health Organization (WHO) global estimations in 2012, 1,000,000 deaths occurred and majority of them among children were less than five years old [1]. Acute kidney injury (AKI) is a common complication of severe malaria (SM) in adults, affecting up to 40% of patients [1] [2]. In the absence of appropriate renal replacement therapy (RRT), the case fatality rate approaches 75% [1] [2].…”

Section: Introductionmentioning

confidence: 99%

“…Acute kidney injury (AKI) is a common complication of severe malaria (SM) in adults, affecting up to 40% of patients [1] [2]. In the absence of appropriate renal replacement therapy (RRT), the case fatality rate approaches 75% [1] [2]. Clinically and pathologically, AKI in adults with SM resembles acute tubular necrosis [3].…”

Section: Introductionmentioning

confidence: 99%

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Acute Kidney Injury during Malaria in Togolese Children

Sabi¹,

Kaza²,

Amekoudi³

et al. 2018

OJNeph

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Objective: To describe clinical, biological and evolutionary profile of Acute Kidney Injury (AKI) due to Severe Malaria in the pediatric department. Methodology: This was a retrospective descriptive study that took place from January to December 2012. It has been included children aged 0-15 years admitted for severe malaria with positive thick drop. AKI was defined by using the modified RIFLE (Risk Injury Failure Loss End stage) classification for Pediatrics. Results: 338 children admitted for severe malaria were included. AKI was diagnosed in 24 children, a prevalence of 7.1% according to pRIFLE classification: RISK in 10 (3%), INJURY in 9 (2.6%) and FAILURE in 5 (1.5%). The average age was 8.16 ± 4.2 years. Clinical features were dominated by hemoglobinuria in 87.5%, oliguria, vomiting and fever in 75%. The biological features were dominated by severe anemia (Hb < 6 g/dl) in 79.2% of cases. Hyperkalemia (K > 5.5 mmol/l) was found in 2 cases. The mean parasitic density was 22,120 trophozoites. Malaria was treated primarily with artemether in 83.3% of the cases. Dialysis was indicated in 2 cases for menacing hyperkalaemia, but was not done because of lack of financial means. In one case, hyperkalaemia was successfully treated with symptomatic measures, but in the second case, these measures were not allowed to normalize kalaemia, and death occurred. Conclusion: Acute post-malarial renal failure secondary to tubular necrosis may be the dominant clinical features of severe malaria. Death may occur. Preventing malaria would be the best way to avoid it.

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Acute Kidney Injury Is Common in Pediatric Severe Malaria and Is Associated With Increased Mortality

Abstract: Acute kidney injury is common in severe malaria and associated with short- and long-term mortality developing in 50% of cases after admission. Cystatin C and BUN are associated with the severity of AKI, are elevated at admission and predict mortality.

Cited by 79 publications

References 42 publications

Dynamic interactions ofPlasmodiumspp. with vascular endothelium

Dynamic interactions ofPlasmodiumspp. with vascular endothelium

Incidence and epidemiology of acute kidney injury in a pediatric Malawian trauma cohort: a prospective observational study

Acute Kidney Injury during Malaria in Togolese Children

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